Archived: Link House

Updated 9 March 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This was an unannounced comprehensive inspection which took place on 6 and 7 February 2018. This inspection was carried out by an inspector and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection, we reviewed all the information we held about this service. This included previous inspection reports and notifications the provider is required by law to send us about events that happen within the service. We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

During this two-day inspection we spoke face-to-face with eight people who lived at the home and five visiting relatives or friends and a GP. We also talked with various managers and staff including, the registered manager, area operations manager, quality and compliance manager, three nurses (including the clinical lead), two team leaders, six care workers and the activities coordinator. We also spoke with the chef who is employed by a separate provider. We also observed the way staff interacted with people living in the home and performed their duties. During lunch on both days of the inspection we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Records we looked at included eight people’s care plans, six staff files and a range of other documents that related to the overall management of the service including, quality assurance audits, medicines administration sheets, complaints records, and accidents and incident reports.

We also contacted various health care professionals who worked with staff to provide care to people living in the home and the Merton Seniors Forum. We received verbal feedback from a district nurse and a written dignity in care report produced by Merton Seniors following their recent visit to the home.

Updated 9 March 2018

Link House is a ‘care home’. People living there receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home can accommodate up to 52 older people across three floors, each of which have separate adapted facilities. The first floor specialises in supporting people with nursing care needs, whilst the ground and second floors support people with personal care needs. At the time of our inspection 32 people were residing at the care home, of which two-thirds were living with dementia.

At the last comprehensive CQC inspection of this home in September 2016 we found the provider to be in breach of two of their legal requirements. We therefore rated the service ‘Requires Improvement’ overall and for the two key questions, ‘Is the service caring and well-led?’ This was because the service did not have suitable arrangements in place to ensure people were always treated with dignity and respect and management oversight and scrutiny was effectively implemented.

We undertook a follow up focused inspection in February 2017 and found the provider had followed their action plan to improve and met their legal requirements. However, we did not change the service’s overall rating at the time because we wanted to be sure they could sustain these improvements over a longer period of time.

At this comprehensive inspection we found the service continued to make the necessary improvements. We saw action continued to be taken to ensure staff received specific guidance and training so the remained aware how to treat people with dignity and respect, particularly during mealtimes. In addition, we saw the provider continued to have appropriate arrangements in place to monitor the quality and safety of the service people received. This helped managers and senior staff check people were consistently experiencing good quality care and were quick to address any issues these governance audits identified. We have therefore improved the service’s overall rating from ‘Requires Improvement’ to ‘Good ‘and for all five key questions, ‘Is the service safe, effective, caring, responsive and well-led?’

The service had a registered manager who had been in post for a year and a half. A registered manager is a person who has registered with the Care Quality Commission (CQC). Registered managers like registered providers are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager had a positive impact at the home and was highly regarded by people living there, relatives and staff.

People living at the home and visiting relatives told us they were generally happy with the service provided at Link House. We saw staff looked after people in a way which was kind and caring. Our discussions with people living in the home and their relatives supported this.

There were robust procedures in place to safeguard people from harm and abuse. It was clear from comments we received from staff they were familiar with how to recognise and report abuse. The provider assessed and managed risks to people’s safety in a way that considered their individual needs. Staffing levels appeared to be adequate. The premises and equipment were safe for people to use because managers and staff routinely carried out health and safety checks. The home looked clean and no infection control or food hygiene issues were identified. Arrangements for managing medicines safely had improved in the last six months and the number of medicines errors or near misses had been significantly reduced as a result. Staff recruitment arrangements were robust for new staff. However, the provider does not have a policy for renewing Disclosure and Barring Service (DBS) checks for existing members of staff. We discussed this issue with senior managers who agreed to look into this matter at provider level.

People said Link House was a homely and comfortable place to live. Bedrooms were personalised and the building was well-maintained. We saw the provider had made some recent changes to the environment to make it more suitable for people living with dementia. However, we found no consistency in relation to the pictures, photographs or signage that were being used to help people identify their room. We discussed this matter with the registered manager who agreed to ask people living in the home, or those acting on their behalf, how they might make it easier for people to identify rooms that were important to them.

Staff received appropriate training to ensure they had the right knowledge and skills needed to perform their roles effectively. People were supported to eat and drink enough to meet their dietary needs. People on the whole said they liked the quality of the meals they were offered. Managers and staff were aware of their duties under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff sought people's consent before providing any care and support and followed legal requirements when people did not have the capacity to do so. They also received the support they needed to stay healthy and to access health care services.

We observed staff providing personalised care to people which was tailored to their individual needs and wishes. Each person had an up to date and person centred care plan, which set out how their care and support needs should be met by staff. These were reviewed regularly. Staff communicated with people using their preferred methods of communication. This helped them to develop good awareness and understanding of people's needs, preferences and wishes. Staff were also knowledgeable about people’s backgrounds and cultural heritage. Staff encouraged people to actively participate in meaningful leisure activities that reflected their social interests and to maintain relationships with people that mattered to them. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. When people were nearing the end of their life, they received compassionate and supportive care.

People were given choices about most aspects of their daily lives. However, we also received some mixed feedback from people about the choice of food they were offered at mealtimes. Staff supported people to choose their meals they wanted to eat the day before, which meant people might not remember the meal choices they had made. We discussed this issue with the managers who agreed to review how they supported people to make a real informed choice about the meals they ate.

People and relative’s felt comfortable raising any issues they might have about the home with managers and staff. The service had arrangements in place to deal with people’s concerns and complaints appropriately. The provider routinely gathered feedback from people living in the home, their relatives and staff. The provider also worked in close partnership with external health and social professionals and bodies. It was evident from the registered managers comments they understood their registration responsibilities particularly with regards to submission of statutory notifications about key events that occurred at the service.